Safety netting is a diagnostic strategy or consultation technique to help manage diagnostic uncertainty. It helps ensure patients undergoing investigations for, or presenting with symptoms which could indicate serious disease, are followed up in a timely and appropriate manner. The term safety netting encompasses a wide range of actions and procedures. These include actions used at an individual GP-patient consultation level and procedures implemented at a practice level. Safety netting is particularly important for suspected cancer, where symptoms are common and often non-specific.

The concept of safety netting was first introduced by Roger Neighbour[1], who considered it a core component of the general practice consultation. Neighbour broke down the process into 3 key questions:

1. If I’m right what do I expect to happen?

2. How will I know if I’m wrong?

3. What would I do then?

Despite this work being widely cited, there has been little progress on how to interpret and apply diagnostic safety netting in practice.

There is no peer-reviewed evidence on the effectiveness of safety netting in primary care for patients with suspected cancer. The limited literature that does touch on safety netting is largely based on significant event analysis (SEA)* of cancer diagnosis, recommending safety netting as a key action for improving the diagnostic process[1,2].

CRUK’s Early Diagnosis Advisory Group (EDAG) have funded the University of Oxford to do some peer-reviewed research to follow up on this work. The study will investigate current safety netting practice and develop comprehensive safety netting recommendations. The project is due to report towards the end of 2017.

National guidelines for suspected cancer referral

The NICE guidelines for suspected cancer referral suggest that those at higher risk of cancer but who do not meet referral criteria are recommended for safety netting.

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